1.

Change Management Documents

1.1 Change Description

 Description of the Change: Eye care facility.

 Purpose: To provide affordable eye care treatment.
 Scope / Reach / Areas of Impact: New facility establishment inside the campus.
 Constraints: Cost of establishment.

1.2 Stakeholder Map

Identifying key stakeholders and their communication preferences is very important as they’ll
need to be updated throughout the change implementation.

Keep Satisfied Manage Closely

High Department Heads Board of Directors.
Level of Influence

Chief financial officer.

Chief technical officer.
CEO
Mediu Operations Manager Procurement Manager Sponsors
m Construction Manager HR Manager
Low Project Manager

Monitor Keep Informed

Low Medium High

Level of Interest

1.2 Gap Analysis

Current Future Resources

Focus State State Gap Action Priority Start End
01 Eye
care
New Facility No Facility facility 100% Establishment High

1.3 Change Impact Assessment

This is an analysis of the potential impact of a proposed change. It evaluates aspects such as its
scope, cost, timeline, priority among other things.

Levels Scor
Questions
1 2 3 4 5 e
Reach and Purpose
Fits with
current Changes to
A change to Transforms Ground
processes, processes,
What is the scope processes, processes, breaking,
workforce organizational 4
of change? staffing, organizational unprecedented
, skills, structure,
models or tech structure culture change
minimal roles
changes
Well-
End result
defined Well defined, Defined, but Not defined,
Is the outcome of unknown,
and clear, but objectives objectives uncertain 1
this initiative clear? objective
achievable unclear ambiguous objectives
evolving
objectives
What part(s) of the Cross
More than one
organization is/are Single 2-3 similar functional, Entire
organization
affected by this function functions multiple organization
involved
change? locations
Included
in
Included in
What priority does business Legislative or Directly Critical, all
business plan,
this project have plan, policy driven, aligned and resources
resources 2
for the shared not aligned to contributes to needed
have been
organization? resources strategic plan strategic plan allocated
allocated
with equal
priority

Financials

What is the total Less than

Up to 500K Up to 1M Up to 5M Over 5M
budget? 100K

No, neither
Yes, Yes, project Partially,
project
absorbed implementatio implementatio
implementatio
Is the budget from n and n costs
n nor No funding 1
committed? existing operating committed,
operation
operation costs not operating
costs
al budgets committed costs
committed

1.4 Implementation Plan

You need an action plan in order to effectively submit, evaluate, authorize and manage and
control the change requests. This is an action plan that explains the steps that will be taken to
implement a change and a timeline for their execution.
 Strategy Timeline
Planned Planned Planned
Priority Task Assigned Status Start Finish Duration
High Planning Planning team 100% 3-Jan 17-Jan 3 weeks
Medium Analysis Planning team 100% 1 week
Board of
Low Select strategy directors 0% 1 week

Process Timeline
Planned Planned Planned
Priority Task Assigned Status Start Finish Hours
Work breakdown structure Project manager 50% 2 weeks
Schedule Project manager 50% 2 weeks
Resources Project manager 75% 1 week
Budget Project manager 25% 1 week

Action Timeline
Planned Planned Planned
Priority Task Assigned Status Start Finish Hours
Construction
Infrastructure
Dept. 50% 1 week
Equipment Purchase Dept. 75% 2 weeks
Staffing HR 25% 2 weeks
Operations 0%
Review

1.5 Communication Plan

Action/Event Project Target stakeholders Method of Owner/Responsible Frequency

phase communication
Planning Planning CEO/Directors/ CFO Face to Face Project manager Once in a week
meeting
Infrastructure Construction CEO/Directors/ CFO Face to Face Head of Engineering Dept. Twice in a Month
meeting
Instrument Construction CEO/Directors/ CFO Virtual meeting Head of Purchase Dept Twice in a Month
procurement
Staffing Operations CEO Virtual meeting HR Head Twice in a Month
1.6 Change Order Request Form
A change order request form is a document that allows internal team members, clients or any
other stakeholder to suggest changes to a project or organization.

CHANGE REQUEST FORM

Change Description
Project Name: Change Name: Number:

Requested By: Contact: Date:

Description of Change:

Reason for Change:

Priority [Circle One]: 1. High 2. Medium 3. Low

Impact on Deliverables:

Impact of Not Responding to Change (and Reason Why):

Date Needed: Approval of Request: Date:

Change Impact
Tasks/Scope Affected:
Cost Evaluation:
Risk Evaluation:
Quality Evaluation:
Additional Resources:
Duration:
Additional Effort:
Impact on Deadline:
Alternative and Recommendations:
Comments:

Sign Offs
[Circle One]: 1. Accepted 2. Deferred 3. Rejected 4. More Info
Requested

Comments:
Project Manager Signature: Date:
Decision Maker Signature: Date:
1.7 Change Order Form
Once a change order request has been approved by the change control board, a change order
form can be issued, to begin the execution of the change as soon as possible.

CHANGE ORDER FORM

Project: Eye care facility External: Internal: X

Order #: 1234 Date:

Reason for
Change: Provide affordable treatment.

Change Description:

Requested By:
Company:
Address
:
Phone/Email:

Approval Signature Date

1.8 Change Log
A change log is a document that helps document any changes that have been implemented over
a time period.

Date
Work Expected
# Type Description Begins Status Priority Assigned Resolution Action Impact
Eye care
1 New Facility facility Open High One year Scope

2. Change Management Team

Describe all the different change management roles that will help execute the change. Ideally,
there should be a change control board in charge of approving or rejecting changes along with
other roles such as change agents and change champions.

Role Name Signature © Date

Change Control Board
Member

Change Control Board

Member

Change Agent
(if applicable)

Change Champion
(if applicable)

Communications Manager
(if applicable)

Project Management
Office Manager
(if applicable)